Healthcare Provider Details

I. General information

NPI: 1316087901
Provider Name (Legal Business Name): AMY RUTH GERSON PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: AMY RUTH COHEN

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21A MUZZEY ST
LEXINGTON MA
02421-5202
US

IV. Provider business mailing address

12 CLEMATIS RD
LEXINGTON MA
02421-7117
US

V. Phone/Fax

Practice location:
  • Phone: 781-862-5623
  • Fax: 781-860-5268
Mailing address:
  • Phone: 781-862-5623
  • Fax: 781-860-5268

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number4753
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number4753
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number4753
License Number StateMA
# 4
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number4753
License Number StateMA
# 5
Primary TaxonomyY
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number4753
License Number StateMA
# 6
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number4753
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: